Oxyhyperglycemiaと糖尿病との関係について

第1報胃切除者における検討

抄録

The oral glucose tolerance test (GTT) and intravenous tolbutamide test were performed in 68 subjects with history of gastrectomy and serum immunoreactive insulin (IRI) response curve as well as blood glucose level were determined during these tests. Besides, the same examinations were also carried out both before and after gastrectomy in another 26 subjects. The shift of these results by surgery or the duration after that were investigated in special reference to the pathogenic effect of gastrectomy on diabetogenesis.
1) of 68 subjects with history of gastrectomy 61.8% exhibited oxyhyperglycemia, 10.8% probable diabetes, and 10.3% diabetes in GTT, and these percentages were quite independent on the duration after gastrectomy. The frequency of probable diabetics or diabetics was not only high in the subjects more than 40 years of age, but increased gradually with aging.
2) The glucose tolerance was impaired by gastrectomy in the cases whose glucose tolerance had been found to be diabetic prior to surgery, however, of 23 subjects diagnosed as nondiabetic, oxyhyperglycemic, or probable diabetic before surgery 18 cases exhibited oxyhyperglycemia after gastrectomy, and no cases could be observed to have shifted to the probable diabetics or diabetics.
3) Observing 11 cases with oxyhyperglycemia during 1-4 years, no cases could be found to have shifted to probable diabetics or diabetics.
4) Many cases of nondiabetes or oxyhyperglycemia showed high IRI response after glucose load, namely, serum IRI. was remarkably elevated more than 100μU/ml at 30-60 minutes and restored at 120-180 minutes, however the most interesting point was that the similar IRI response was also observed in the normal students when glucose was loaded into the jejunum through the tube, whereas, the initial rise of IRI at 30 minutes after glucose loading was diminished (35-60μU/ml) in the cases with probable diabetes.
5) Both serum IRI response during GTT and glucose tolerance curve were found to have shifted to be parallel before and after gastrectomy.
6) No particular correlation could be observed between serum IRI response and the duration after gastrectomy in each group with different glucose tolerance.
7) Although the initial fall of blood glucose level after tolbutamide infusion remained within normal range, the time required for reaching to minimum and that necessary for restoring were tended to have delayed in all cases with oxyhyperglycemia, besides, these results were independent on the duration after gastrectomy.
8) The results described above considered to suggest little possibility that the subjects with oxyhyperglycemia after gastrectomy proceed to diabetes in the cases without diabetic disposition.